March 01, 2018

Anthem Rescinds Pay Cut for Same-Day Services

The American Medical Association (AMA) announced February 23, 2018, that Anthem has decided not to move forward with its policy to reduce payments for evaluation and management (E&M) services reported on the same day as clinical procedures with a Current Procedural Terminology (CPT) modifier 25.

Anthem’s decision represents an important step forward toward addressing ongoing disputes with Anthem over a variety of policies that have a negative impact on patient care. It came in response to organized medicine’s strong objections to the E&M services policy.

In December, the AMA announced Anthem had adjusted its proposed policy to reduce payments for E&M codes appropriately reported with a CPT modifier 25 by 25 percent instead of 50 percent, as originally planned. The AMA and other physician organizations continued to voice strong objections to this reduction in physician payment and presented additional analyses of the relevant codes and services to Anthem. The policy was scheduled for implementation on March 1.

The American College of Radiology, along with the AMA and many other stakeholder groups, will continue to oppose Anthem’s restrictive policies for advanced imaging in hospital outpatient facilities, retrospective denial of payment for emergency room visits, including advanced diagnostic imaging services, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.